Living With Chronic Pain

What Are the Risks and Benefits of CBD for Chronic Pain Management?

CBD is readily available these days, leading people to ask about the risks versus benefits of CBD oil and cream. I’d previously shared about CBD oil; since then, it’s become so widely available online and in stores like Bed Bath and Beyond I thought an update would be helpful. As I’ve discussed many times, anything you swallow can have an impact on your health. It’s understanding those potential issues that’s so important for patients and providers. Anyone can claim anything. Especially if there’s no oversight or guidelines defining appropriate parameters. As a “supplement,” CBD falls into this category. I couldn’t help but wonder- are all CBD products created equal?

The most precarious and debilitating symptoms suffered by patients with chronic pain is stiffness, and decreased movement within the joints, all of which can be severe and worsen over time. In addition, there are other symptoms that are just as troublesome, such as anxiety and depression. Not only that, but it can become especially trying when you have to contend with other medical problems that tend to coexist with arthritis, like heart disease, diabetes, and obesity.

This is where studies show CBD oil may help.

What is CBD Oil?

CBD is short for cannabidiol. It is one of more than 80 chemical cannabinoids found in the marijuana plant Cannabis sativa. Thus, cannabis oil, or CBD oil as it is more commonly known, is an oil that is developed using this particular compound.

Although CBD oil is just now becoming fairly mainstream, largely because of the debates surrounding medical marijuana, cannabis actually has a long history of providing relief in many different countries around the world.

CBD’s Long History

In June 2015, National Geographic ran a story about how Siberian burial mounds as far back as 3000 B.C. were found to contain charred cannabis seeds. Cannabis has also been used in Chinese medicine for thousands and thousands of years.

The article went on to explain how American use of cannabis goes back to our country’s founding fathers as well. In fact, George Washington himself grew hemp at his plantation estate and the location of his burial, Mount Vernon.

Because of the somewhat tumultuous history marijuana has had with the law (regarding whether it is illegal or not), research on the positive properties of hemp’s derivatives such as cannabidiol oil has been extremely limited.

How Cannabis Oil Works

The body’s endocannabinoid system has two cannabinoid receptors: CB1 and CB2. A majority of CB1 receptors are located in the brain and are associated with cognitive actions related to coordination, mood, thinking, memory, and appetite. The CB2 receptors, on the other hand, can be found in the immune system. This makes them more responsible for the body’s response to pain and inflammation.

Tetrahydrocannabinol, or THC, attaches to the CB1 receptors, which explains why smoking or otherwise ingesting marijuana affects users on a cognitive level. This is the cannabinoid regulated by the government because it impacts cognitive function.

CBD impacts the CB2 receptors. And it does so indirectly, not by attaching to the CB2 receptor, but by enticing the body to make more of its own cannabinoids. This creates a positive effect on the body’s pain and inflammation responses.

One of the primary CBD oil benefits for chronic pain sufferers is its positive impact on decreasing pain and depression: 

1) A study published in the journal Pain analyzed whether CBD could prevent osteoarthritis pain and joint neuropathy. Based on their findings, researchers affirmed that it did both because it decreased joint inflammation and served as a protectant to the nerves. 

2) CBD Oil relieves other chronic pain conditions as well. Research published in Therapeutics and Clinical Risk Management indicates that cannabinoids have been helpful with easing pain for individuals diagnosed with conditions such as multiple sclerosis and cancer. Other studies have reported positive effects for individuals taking CBD to ease their fibromyalgia pain with a few experiencing mild side effects such as dry mouth, drowsiness, and dizziness. 

3) CBD Oil has also been linked to a variety of mental health benefits, such as a reduction in anxiety. Research suggests that it is so effective in this regard that it has considerable potential as a treatment for multiple anxiety disorders. This is extremely important because as the Arthritis Foundation says, the depression rates of those diagnosed with certain types of arthritis “can be between two- and ten-times greater than the rates of the general population.”

Is Cannabidiol Legal?

CBD is readily obtainable in most parts of the United States, though its exact legal status is in flux. All 50 states have laws legalizing CBD with varying degrees of restriction, and while the federal government still considers CBD in the same class as marijuana, it doesn’t habitually enforce against it. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. Currently, many people obtain CBD online without a medical cannabis license. The governments position  on CBD is confusing, and depends in part on whether the CBD comes from hemp or marijuana. The legality of CBD is expected to change, as there is currently bipartisan consensus in Congress to make the hemp crop legal which would, for all intents and purposes, make CBD difficult to prohibit.

Will it cause a positive drug screen? 

Maybe. CBD itself would not report positive for marijuana or marijuana metabolite. If the CBD product contains THC though, it is possible, depending on usage patterns, that the use of these products could cause a positive urine drug test result for marijuana metabolites. For example, in some states, CBD may contain up to 5% THC. That’s why it’s imperative to know where the CBD originates from and what exactly is in it before using.

It is important to remember that for federally-mandated drug tests, the use of CBD or “medical marijuana” would not be considered an alternative medical explanation for the positive test result. Moreover, as a Schedule I substance, CBD remains illegal at the Federal level. While there are some states that permit the sale of CBD, many of these states only permit relatively low levels of THC in the CBD product. This entire issue can be made irrelevant if you purchase CBD oil without THC. Purchasing from a reputable facility and being aware of what’s in your product is clearly an important factor.

Employers need to stay informed about the ever-changing landscape of marijuana and its derivatives because situations like this may arise. Additionally, employers need to ensure their company’s substance abuse policy language clearly reflects their position on marijuana and the use of CBD products.

Medication/Drug Interactions

CBD can sometimes interact with certain prescription medications, primarily those that are changed and broken down by the liver which increases the medication level in your blood. You may have heard of the “grapefruit rule” which suggests that the citrus fruit can impair how your body absorbs certain drugs — mainly cholesterol medications, blood pressure drugs, pain medicines, antidepressants, hormone replacement therapy, anti anxiety meds, indigestion meds, and allergy pills. That same mechanism occurs with CBD. Both grapefruit and CBD can boost levels of other medications in your blood. This can mean your blood pressure cholesterol agent should be lowered depending on individual responses. Those on Coumadin, a well know blood thinning agent, must check their levels and watched closely.

How intensely this all plays out in your body mainly depends on the dosage of both the medication and the CBD that you’re taking. If the concentration of CBD is high enough, it could inhibit the activity of those enzymes, so you risk getting more of the other drug into your system. On the flip side, very low amounts of CBD don’t seem to have that much of an effect on how well your body processes other medications. Unfortunately, there hasn’t been enough research to determine how much CBD it takes to cause an issue.

Just like anything else you put in or on your body, it’s best to err on the side of caution and know, to the best of your ability, exactly what the potential side effects are. Before you start, please clear these products with your provider.

Is CBD Oil Safe

The second most common question people have when it comes to CBD oil for pain management or as an anti-inflammatory agent is whether or not it is safe to use. According to top health experts and agencies, the answer is yes. It is safe to use.

While cannabinoid medicine is still in its early stages, unlike marijuana and THC, the risks associated with CBD are extremely low, with not a single case report of CBD overdose in literature. The National Institute on Drug Abuse agrees and states that “CBD appears to be a safe drug with no addictive effects.”

Side effects of CBD include nausea, fatigue, irritability, fuzziness and drowsiness. Therefore, if you’re taking supplements or medications to help you sleep, CBD could enhance these effects even more. It’s important to keep this in mind if you’re performing activities that require maximum alertness, such as driving or operating heavy machinery.

A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. So you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other (unknown) elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.

In the future, it is likely that the Food and Drug Administration (FDA) will also begin to regulate CBD products, providing an additional safety net, as this agency indicates that “increasing public interest” in this substance increases the importance of establishing regulatory parameters. This is especially important in making sure what’s represented as being in the product is accurate. There has been an explosion of new CBD products hitting the market in the past year. We’re seeing reports of many of them having far less CBD than they report or even including no CBD at all. Worse, some have even failed testing for pesticides and dangerous bacteria. The FDA seems to be ramping up enforcement to tackle this problem. For now it’s up to the consumer to be aware.

The bottom line on cannabidiol

Some CBD manufacturers have come under government scrutiny for wild, indefensible claims of  CBD being a cure-all for cancer and other ailments. It is not. While more research is needed it does appear CBD may be a viable option for managing anxiety, insomnia, and chronic pain.  Even though I haven’t had much improvement in my pain with CBD so far, I’m impressed with the fact so many others have. I continue to play with combinations, so who knows what may prove beneficial in the future. What works for one person doesn’t necessarily help someone else. Managing chronic pain is an individual process. That’s why it’s great to have benign, safe alternatives. I investigated what’s available and decided to offer reputable CBD products that have no appreciable THC (a maximum of .03% that originates from hemp, not marijuana) so I can monitor other medications to help patients ensure a safe experience.

First, talk with your provider. If you and your provider find that CBD may be a viable option to improve symptoms, ask these questions before you purchase any CBD product:

  • Does it have THC?
  • Exactly how much CBD is in the product?
  • Where does the product originate from?


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